CF-FC 570E—Payment Transmittal Form

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Privacy notice

Provision of the personal information is required pursuant to the Department of Public Works and Government Services Act, para. 7(1)(d) and s.13 and will be used for the purpose of administrating the Canadian Forces Superannuation Act (CFSA). Refusal to provide the personal information or the provision of incorrect information may result in loss of benefits and/or delays in processing incorrect pension estimates, benefits, or statements. Personal information is protected, and only used and disclosed in accordance with the Privacy Act and as described in Personal Information Bank PWGSC PCU 702 – Federal Pension Administration. Under the Act, individuals have a right of access to their personal information and request correction, if erroneous or incomplete.

Note

This form must be completed electronically. If not possible, please complete it in dark ink using capital letters.

Plan member's personal information

Rank

Surname

Given Names

Plan member's personal information Pension Number

Date of Birth (YYYY-MM-DD)

Preferred language

English French

Service Number

Home address

Apartment Number

Preferred Telephone Number

City

Province

Postal Code

Country

Email Address (optional)

Carefully read instructions before completing

This form is used by the plan member for the purpose of remitting payments in respect of a period of leave without pay and/or a service buyback. This form provides information necessary for accounting purposes.

Send the completed form to the following address together with your payment:

Government of Canada Pension Centre - Mail Facility
150 Dion Boulevard
PO Box 9500
Matane QC
G4W 0H3

Cash payments such as personal cheques and money orders must be made payable to the Receiver General for Canada.

If sending a payment in respect of more than one service buyback, indicate the total of the monthly deduction amount for all service buybacks.

If your payment is made through a direct transfer of funds from a Registered Retirement Savings Plan (RRSP), complete and attach the Canada Revenue Agency form T2033 to this form (in lieu of a cheque or money order).

Part 1 Members: In Part C of the form T2033 indicate "0355495" for the Canada Revenue Agency (CRA) registration number and "Canadian Forces Pension Fund" for the Registered Pension Plan (RPP) name.

Part I.1 Members: In Part C of the form T2033 indicate "1172220" for the CRA registration number and "Canadian Force Reserve Pension Fund" for the RPP name.

Payment information for Service Buyback Payments

Pre-authorized debit arrears
Lump Sum, partial amount
Lump Sum, full amount

Monthly Deduction Amount $

Amount of Payment $

This payment covers the following period:

From (YYYY-MM-DD)

To (YYYY-MM-DD)

Payment information for Leave Without Pay

Pension Contributions

Amount of Payment $

This payment covers the following period:2

From (YYYY-MM-DD)2

To (YYYY-MM-DD)2

For office use only

Form Number

Case Number

Service Number

Pension Number

CF-FC 570E (2015-01-001)

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Date modified:: 2020-12-16

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